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BPH: Medical Management (Benign Prostatic Hyperplasia /Enlarged Prostate)

Throughout a man's life, the prostate may grow and start to cause problems as a man gets older. For many years, surgery was the only relief for this very common problem. Today, medications are the most common method for controlling urinating symptoms of BPH. What are the causes of these symptoms and what are some of the new treatments? The following should help answer that question as well as others.

What is the prostate?

The prostate, part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH?

Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. Urinating symptoms can occur as the prostate enlarges.

What are some of the risk factors for BPH?

Risk factors for developing BPH include increasing age and a family history of this condition.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.

Fill out the AUA Symptom Score and share the results with your health care provider.

How are the urinating symptoms secondary to BPH diagnosed?

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH — ranging from mild to severe.

There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, transrectal ultrasound (this measures the size of the prostate), urine flow study (this measures the speed and strength of the urinary stream), measurement of how much urine is left after urinating (post-void residual urine) and cystoscopy (a fiber-optic instrument inserted into the urethra to examine both the prostate and the urinary bladder).

What are some of the medical treatments available for BPH?

Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. They are usually taken orally, once or twice a day and they work almost immediately. Commonly prescribed alpha blockers include: alfuzosin, terazosin, doxazosin and tamsulosin. Side effects can include headaches, dizziness, lightheadedness, fatigue and ejaculatory dysfunction.

5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent recurrence of symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. . These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.

Combination Therapy: The use of both alpha blockers and 5-alpha-reductase inhibitors result in better amelioration of symptoms and long term benefits than using only one type of drug. However, this improved benefit may be associated with more side effects (possible side effects from both medications).

Phytotherapies: These compounds, also known as herbal therapies, are very popular self treatment remedies. However their effectiveness is not really known but if they provide benefit, it is much less than other medical therapies.

Frequently asked questions:

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer. Still, both problems can happen at the same time. There may not be any symptoms during the early stages of prostate cancer. So whether their prostate is enlarged or not, men should talk to their health care providers about whether prostate cancer screening is right for them.

Which type of drugs are the best?

Alpha blockers work in most patients and provide early relief of symptoms. But alpha blockers may not protect against progression of BPH over time and symptoms or BPH related complications may re-occur. 5-alpha-reductase inhibitors appear to work best in men with large prostates and do reduce the risk of BPH progression over time. The combination of both of these drugs provide the best benefit but also the highest risk of potential side effects.

How do I know if oral medications are the best treatment for me?

If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication or surgical treatment is best for you.

Where can I get more information?

BPH: Diagnosis

BPH: Management

BPH: Minimally Invasive Management

BPH: Surgical Management

Benign Prostatic Hyperplasia (BPH) Treatment Choices

Hormone Health Network's Enlarged Prostate Fact Sheet

Common terms for BPH: enlarged prostate big prostate

 



Reviewed: January 2011

Last updated: April 2013

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BPH: Medical Management (Benign Prostatic Hyperplasia/Enlarged Prostate) Glossary
  • acute: Acute often means urgent. An acute disease happens suddenly. It lasts a short time. Acute is the opposite of chronic, or long lasting.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bladder neck: Area of thickened muscle fiber where the bladder joins the urethra. Acting on signals from the brain, bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra. These muscles also tighten during ejaculation to prevent backflow of semen into the bladder.

  • BPH: Also known as benign prostatic hyperplasia. An enlarged prostate not caused by cancer. BPH can cause problems with urination because the prostate squeezes the urethra at the opening of the bladder.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystoscopy: Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

  • digital rectal examination: Also known as DRE. Insertion of a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities.

  • DRE: Also known as digital rectal examination. Insertion of a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities.

  • ejaculation: Release of semen from the penis during sexual climax (orgasm).

  • ejaculatory: Involved in or related to the structure involved in the release of semen from the penis during orgasm.

  • ejaculatory fluid: Semen.

  • frequency: The need to urinate more often than is normal.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • high blood pressure: Medical term is hypertension.

  • hyperplasia: Excessive growth of normal cells of an organ.

  • impotence: Also called erectile dysfunction or ED. The inability to get or maintain an erection for sexual activity.

  • impotence: The inability to get or maintain an erection of the penis for sexual activity. Also called erectile dysfunction.

  • ions: Electrically charged atoms.

  • libido: Sexual desire.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • penis: The male organ used for urination and sex.

  • prostate: A walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.

  • prostatic: Pertaining to the prostate.

  • PSA: Also referred to as prostate-specific antigen. A protein made only by the prostate gland. High levels of PSA in the blood may be a sign of prostate cancer.

  • PSA test: Also referred to as prostate-specific antigen test. A blood test used to help detect prostate cancer.

  • rectal: Relating to, involving or in the rectum.

  • rectal ultrasound: A diagnostic test that uses very high frequency sound waves to produce an image of the rectum.

  • rectum: The lower part of the large intestine, ending in the anal opening.

  • residual urine: Amount of urine remaining in the bladder after urination.

  • retention: In ability to empty urine from the bladder, which can be caused by atonic bladder or obstruction of the urethra.

  • semen: Also known as seminal fluid or ejaculate fluid. Thick, whitish fluid produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • semen: The thick whitish fluid, produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • Side effects: An action or effect of a drug other than that desired. Commonly it is an undesirable effect (e.g., nausea, headache, insomnia, acute toxic reaction or drug interaction).

  • stage: Classification of the progress of a disease.

  • transrectal ultrasound: Also referred to as TRUS. This is a special kind of ultrasound test in which the sound waves are produced by a probe inserted into the rectum. In men, the structures most commonly examined with this test are the prostate, bladder, seminal vesicles and ejaculatory ducts.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary retention: Failure to empty the bladder totally.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urine flow study: A test in which the patient urinates into a special device that measures how quickly the urine is flowing.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • void: To urinate, empty the bladder.

BPH: Medical Management (Benign Prostatic Hyperplasia/Enlarged Prostate) Anatomical Drawings

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